Monday, April 26, 2010

The Pill Turns Fifty

June 2010 marks the fiftieth anniversary of the birth control pill. At the time of my own adolescence, I had no idea that it had just come on the scene. Like women's lib, drinking at age 18 and conscientious objection, we took this for granted as part of growing up. As a practitioner I prescribe it every day; as often as not it's for a problem that is not directly related to contraception. Many people are still surprised at the multi-tasking the Pill can do in a woman's body.

In reviewing the history of the pill I ran across a 2000 New Yorker article by Malcolm Gladwell about the first days of the pill and in particular the story of Dr John Rock's attempts to make the new birth control pill as acceptable as possible to the leaders of his own Catholic church. Rock worked hard to present the Pill as a "natural" method of birth control to rival the more acceptable "rhythm" method (meaning timing intercourse with the menstrual cycle to try to avoid the days surrounding ovulation). Not only did he try to sell the idea that birth control pills promote the "natural" safe times of the month, but the classic 28 day cycle was created with the pills to mimic what they thought were the "natural" cycles of most women. Another remarkable aspect of the pill was the packaging:it was first marketed in the now familiar plastic round compact in order to pass as a makeup container in a woman's pocketbook, a natural for most women.

Since this time, a great deal of anthropological and endocrine research has shown that the 400 or so menstrual periods that a modern woman gets between her first one and her menopause are mostly a result of modern lifestyle. Before the twentieth century it would be more likely for a woman to have only about one hundred periods with the difference being accounted for by more period-free pregnancies and lactation. Experts wonder what the effects of so much exposure to female hormones, albeit "natural" ones, might be.

In the meantime, we celebrate the gains that oral contraceptives have afforded women and the way in which many of the modern hormone-related afflictions of modern life (acne, heavy or irregular periods, menstrual cramps, polycystic ovaries, and endometriosis) can be managed with this little middle-aged pill.